Staying fit over forty

by Jeff Siegel

The 40th birthday checkup, say doctors, is an opportunity to get a good look at your health and lifestyle and with input from your health care provider, to make decisions to fix what might be broken.

In many ways, Rick Wamre considers himself to be a typical American male. He has a wife, a couple of children, and a mortgage. He follows the local football team, goes to church, and saves for his sons' college educations.

But in a couple of months, he is going to do something that is decidedly untypical for American men. He's going celebrate his 40th birthday with a visit to the doctor for a complete physical.

"If I don't get in the habit of doing it now, it might be too late to get in the habit of doing it later," says Wamre, who owns a magazine publishing company in Dallas. "This is one of those things where you have to do it because it's a good idea, whether you want to or not."

Men, say the studies, spend less time worrying about prevention and well-care than women do. Unfortunately, this can mask the risk for heart attacks, strokes, and cancer later in life. Celebrating your 40th birthday with the first of what should be annual checkups is one of the best presents you can give yourself.

That's because the 40th birthday is not only a milestone in life, but in health as well. This gives men an opportunity to atone for what is often as much as two decades of neglect. Says Lawrence Smith, MD, an internist at Mt. Sinai School of Medicine in New York City: "Gynecological issues get women to a doctor. Too many men don't go between the time they get their college physical and the time something happens to remind them that they are getting old."

That "something" often turns out to be a heart attack, stroke, or cancer in their mid-50s. But that doesn't have to be the case, especially if they begin annual checkups at the age of 40. Men turning 40 can establish a baseline what's normal for them for things like blood pressure, cholesterol, triglycerides, and blood sugar. They can look at their lifestyle, and, with their doctor's help, see what kind of shape they're really in. Then they can decide what, if anything, needs to be done.

Finally, they can establish a relationship with a health care provider, someone they can trust as they age and as more serious medical problems crop up. This, say doctors, is too often overlooked. Men who don't find a personal doctor can find themselves taking advice as well as being treated by providers they barely know, especially in these days of the brave new world of health care.

"Your 40th birthday is a milestone event, and you should use it to focus on the long-term aspects of your health," says Dr. Smith. "It reminds you that while you're not old, you're not indestructible, either."

A 40th birthday exam should include:

A family history

As a general rule, you don't need to be tested for things like colon cancer and prostate cancer until you're 50, unless there's a history of these cancers in your family or you're African-American. This is also the time to find out if any of your blood relatives suffer from diabetes or hypertension, which tend to follow genetic paths. And don't overlook alcoholism, which also seems to run in families.

A complete physical

Don't worry all the old favorites, including the rectal exam, are still part of the process, but this will be the most extensive exam you've ever had, especially if you haven't had one in a few years. Not only are there more things to look at (how many teenagers know their cholesterol levels?), but there is less margin for error. A blood pressure reading that's marginally high when you're 40 raises more concern than the same reading when you're 25, if only because you have less time to fix it and more causes for it.

Risk assessment

There is much more to this, say doctors, than whether you smoke or are overweight, although this is the time to decide to do something about both before they cause even more problems. Among the other topics: Do you live or work around any toxic substances? Is your job causing added stress or depression? Do you get enough exercise? How much do you drink? How many meals do you eat a day? Getting enough fresh fruits and vegetables? Getting enough fiber? How's your hearing? Your vision?

Education

Do you know the relationship between high cholesterol levels and heart disease? What about hypertension and kidney damage? The effects of arthritis as you age? The value of dietary supplements? When should you start taking flu shots? This is the time to ask your doctor questions, and most doctors say they welcome these sorts of inquiries from patients. Make sure you write your questions down ahead of time so you won't get too flustered to remember what was on your mind.

Usually the doctor will start with your pulse and blood pressure and a check of your heart, lungs, and lymph nodes. For anyone in their 40s, the visit should include a rectal examination, plus a stool sample to test for blood. There is also a standard battery of blood tests that should be done, including a complete blood count and a lipid panel to determine cholesterol and other blood fats. Your urine should be sampled for testing, too. Men should have a baseline PSA test , which screens for prostate cancer, and an electrocardiogram (EKG or ECG) if one hasn't been taken before.

The goal of this exam, say doctors, is not to scare the patient. Rather, it's to find out if anything is wrong, and treat it before it gets worse. If you check for something on a yearly basis, you stand a chance of finding problems or diseases at an earlier stage, when they are more easily treated. Lowering cholesterol can ward off heart disease, for example, and finding a tumor while it is still small and confined to one organ often means the difference between cure and death.

"The key these days is prevention," says Jacob Sokol, MD, PhD, the chairman of ambulatory services and community medicine at Nassau County Medical Center. "We've changed our focus, because it's cheaper and more effective to prevent conditions like heart disease than to treat it after the damage has been done."